When Can I Change My Medicare Prescription Drug Plan?

Medicare prescription drug plans, known as Part D, help cover the costs of prescription medications. These plans are offered by private insurance companies that have contracts with Medicare. While beneficiaries can change their Part D coverage, these changes are generally restricted to specific times throughout the year. Reviewing your plan annually is important because costs, covered drugs, and pharmacy networks can change from one year to the next.

Annual Enrollment Period

The Annual Enrollment Period (AEP) provides a yearly opportunity for individuals to make changes to their Medicare coverage. This period occurs from October 15 to December 7 each year. Any changes made during AEP become effective on January 1 of the following year.

During this time, you can switch from one Medicare Part D plan to another, or enroll in a Part D plan if you did not have one previously. You can also switch between Medicare Advantage Plans, or move between Original Medicare and a Medicare Advantage Plan (which often includes drug coverage). This period allows beneficiaries to evaluate their current plan against their evolving healthcare needs and upcoming plan changes.

Medicare Advantage Open Enrollment Period

The Medicare Advantage Open Enrollment Period (MA OEP) runs annually from January 1 to March 31. During this period, individuals already enrolled in a Medicare Advantage Plan can switch to a different Medicare Advantage Plan.

You also have the option to disenroll from a Medicare Advantage Plan and return to Original Medicare. If you choose to return to Original Medicare, you can then join a standalone Part D plan. This enrollment period is distinct from the AEP because it is specifically for those already in a Medicare Advantage plan and does not allow individuals with only Original Medicare to switch Part D plans.

Special Enrollment Periods

Special Enrollment Periods (SEPs) allow individuals to make changes to their Medicare prescription drug coverage outside of the standard enrollment periods. These periods are triggered by specific life events that alter your healthcare needs or coverage situation. The duration of an SEP can vary depending on the qualifying event.

One common SEP occurs if you move to a new service area where your current plan is not available, or if your plan leaves the Medicare program or significantly reduces its service area. You may also qualify for an SEP if you lose other creditable prescription drug coverage, such as employer-sponsored health benefits. Another qualifying event is if you gain or lose eligibility for financial assistance programs like Extra Help, which assists with Medicare Part D costs.

SEPs can also be granted if you move into or out of a qualified institutional facility, such as a nursing home. If you are diagnosed with a chronic condition and become eligible for a Special Needs Plan (SNP), you may have an SEP to enroll in such a plan. Contact Medicare or your plan provider to confirm eligibility, as specific documentation may be required.

Steps to Change Your Plan

Changing your Medicare prescription drug plan involves a few steps once you identify an eligible enrollment period. The main method for reviewing and selecting a new plan is through the official Medicare website. You can use the Plan Finder tool on Medicare.gov to compare available plans based on your specific prescription drugs and preferred pharmacies.

Alternatively, you can call 1-800-MEDICARE (1-800-633-4227) to speak with a representative who can assist you with plan comparisons and enrollment. You also have the option to contact the new plan directly to enroll. When you enroll in a new plan, your previous plan will automatically be disenrolled, preventing any overlap in coverage. After submitting your enrollment, you should receive confirmation from your new plan regarding the effective date of your coverage.